| Doctor Name: | JESSICA NEVILL |
| NPI Number: | 1407276116 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 39002586A |
| Business Practice Address: | 1211 E National Ave Brazil, IN - 478342717 |
| Business Phone Number: | 8124488801 |
| Business Fax Number: | |
| Mailing Address: | Po Box 4323, TERRE HAUTE |
| State: | IN |
| Postal Code: | 478040323 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/21/2014 |
| NPI Last Update Date: | 04/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 39002586A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |